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Failing to plan is planning to fail: advance care directives and the Aboriginal people of the Top End

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Advance care directives can enable Aboriginal people to fulfil their end-of-life wishes to die in their community

The United Kingdom’s great wartime Prime Minister, Sir Winston Churchill, once said “he who fails to plan is planning to fail”. These prescient words resonate for advanced care planning and end-of-life decision making.

Advance care directives (ACDs) are used in all Australian states and territories, but take different forms and names. In the Northern Territory, they are known as advance personal plans (APPs).1 An APP allows not only for advanced consent decisions in relation to life support and palliative care, but also the appointment of a substitute decision maker. The powers of the substitute decision maker under the Advance Personal Planning Act 2013 can include health and financial matters.1

ACDs have a valuable role for Aboriginal and Torres Strait Islander (respectfully referred to hereafter as Aboriginal) Australians for two important reasons. First, Aboriginal people suffer from higher rates of life-limiting conditions and burden of disability approaching end of life.2 Second, because of their strong connections to land and community, Aboriginal people from rural and remote regions have a strong preference to “die at home connected to land and family”.